Why States Should Think Twice Before Banning SSPs

Although syringe services programs (SSPs) have played an important role in turning the tide on the United States’ overdose crisis, they have seen growing backlash in some states. Idaho repealed its SSP authorization in 2024, and West Virginia is now attempting the same with HB 4413. Certain localities in California and Colorado have also tried banning the programs (with mixed results), while others in Washington and Oregon have added restrictions that make it harder for SSPs to operate there. However, doing away with these time-tested, lifesaving programs will cost lives as well as money.

What SSPs Do

• Prevent infectious disease outbreaks

SSPs have been preventing the spread of infectious diseases between people who inject drugs and within their communities for more than 40 years. These organizations distribute sterile injection equipment to reduce needle sharing, educate individuals about disease prevention, offer on-site HIV and hepatitis C testing, and link clients to additional care. SSPs are proven to reduce the incidence of HIV and hepatitis C by about 50 percent, benefiting rural and urban communities alike.

• Help avoid overdose deaths

As of 2019, 94 percent of SSPs in the United States also provided essential services to prevent overdose deaths. Such programs teach clients how to identify and address an overdose—including rescue breathing—and distribute the overdose-reversal medication naloxone. Many SSPs also help clients avoid overdose by providing drug-checking services, such as offering fentanyl or xylazine test strips for clients to test their own drugs or checking drugs on-site and sharing the results to improve community awareness of any contaminants in the current supply. Policies and programs that facilitate widespread distribution of naloxone and drug-checking equipment or services reduce population-level overdose fatalities.

• Build trust and connections

In addition to helping clients stay safer in the short term, SSPs build trust and connect people to a wide range of life-changing resources and services for long-term benefit. This often includes providing referrals and warm hand-offs to treatment for substance use disorder or offering medications for opioid use disorder on-site or as part of an overdose response. Trust can help reduce stigma and improve engagement with the healthcare system. These connections are key to why SSP participants are five times more likely to enter treatment and three times more likely to reduce their injections and overall drug use.  

• Keep communities cleaner and safer

In addition to providing direct services, the majority of SSPs also collect used injection equipment, provide safe disposal tools, and conduct local clean-ups. These activities facilitate cleaner public spaces and fewer needlestick injuries for first responders, law enforcement, and others. SSP participants are more likely than their counterparts to properly dispose of used syringes, and establishing an SSP in a neighborhood with demand for these services can actually reduce syringe litter. Proper needle and syringe disposal keep all community members safer. Additionally, a means for proper disposal—coupled with increased transparency and decreased stigma—means SSP participants are more likely to disclose to first responders and law enforcement if they have a needle in their possession, thereby reducing the risk of needlestick injuries.

• Save taxpayers money

Because SSPs (like many public health programs) operate upstream to prevent disease and death, they generate an impressive financial return on investment for taxpayers. More than three decades of research demonstrate that, on average, SSPs save about $6 to $7 per dollar invested just by preventing the need for HIV treatment. A recent study found that an organization with a $500,000 budget would only need to prevent three new cases of HIV each year to come out ahead financially. This cost-effectiveness is even greater when we look beyond HIV prevention. For example, a North Carolina naloxone distribution program prevented roughly 300 opioid overdose deaths over a two-year period, translating to a community benefit of $2,742 per dollar spent. Organizations can optimize their cost savings by integrating their work into a comprehensive program.

When Policy Hinders SSPs

When lawmakers restrict SSPs through excessive regulation or direct prohibitions, communities suffer the consequences. Keeping these programs from operating according to local needs—or banning them altogether—quickly erodes protection against infectious disease transmission. In West Virginia, excessive restrictions on existing SSPs exacerbated past HIV outbreaks tied to injection drug use. A modeling study in Scott County, Indiana, showed that closing SSPs would lead to an almost immediate uptick in new HIV cases; within five years, the incidence of new cases would reach 60 percent above the level expected had the SSPs continued operating. These risks extend beyond disease prevention. When Pueblo, Colorado, banned SSPs, naloxone distribution fell immediately—thereby increasing the likelihood of overdose deaths. Moreover, the program closures eroded trust and expertise. Naloxone-seeking did not fully rebound after the ban was overturned, and SSPs distributed 900 fewer kits than usual during a three-month follow-up.

Lessons for Policymakers

Although it might seem counterintuitive, SSPs have saved lives, improved health, facilitated treatment, and benefited communities for decades. Consequently, overregulating these programs or preventing them from operating can increase health, social, and financial risks in our communities. Lawmakers who want to reduce illicit substance use and associated harms should authorize SSPs to operate and support flexible policies that allow them to adapt to local needs.